Susan

1
Susan

• Case study

2
Part 1 the story so far

• 25-year old unmarried mother with history of
  acute severe exacerbations
• PEF 150 L/min so admitted
• At AE, respiratory rate 30/min, pulse 145/min
• Referred to ICU.

3
Part 1 questions

• Did the GP act appropriately when consulted?
• Did the GP act appropriately when called?
• What factors in Susans history ring alarm bells?

4
Part 1 questions

• How would you define Susans asthma attack?
• Was her management in AE and as an inpatient
  appropriate?
• Were the discharge arrangements appropriate?

5
Part 1 key point

• Assess and act promptly in acute asthma admit
  patients with any features of a life threatening
  or near fatal attack, or severe attack persisting
  after initial treatment

6
Part 2 the story continues

• Susan fails to attend clinic appointments and has
  poor compliance with therapy
• Acute severe exacerbation in patient with history
  of previous such attacks and adverse
  psychosocial/behavioural factors
• Fatal attack

7
Part 2 questions

• Were there any factors that could have predicted
  Susans death?
• What could have been done about the risk to
  Susan?
• How did the actions of Susans mother contribute
  to the situation?

8
Part 2 key points

• Assess and act promptly in acute asthma admit
  patients with any features of a life threatening
  or near fatal attack, or severe attack persisting
  after initial treatment

9
Part 2 key points

• Self-management is effective offer
  self-management to all patients with asthma
  reinforce with a written asthma action plan that
  gives patient-specific advice on signs of
  deteriorating asthma and appropriate actions to
  take (see Asthma UK website, www.asthma.org.uk)

10
Part 2 key points

• Healthcare professionals must be aware that
  patients with severe asthma and one or more
  adverse psychosocial factors are at risk of death